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General NPI Number Information
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NPI Number | 1336411594
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Entity Type | Organization
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Legal Business Name | PEDIATRIC INFECTIOUS DISEASES AND TRAVEL CLINIC OF LAREDO, PA
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 3826 CRESTWIND
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City | LAREDO
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State | TX
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Zip | 78045-8190
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Country | US
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Telephone | 917-916-9172
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Fax |
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Provider Business Mailing Address
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Address Line | 3826 CRESTWIND
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City | LAREDO
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State | TX
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Zip | 78045-8190
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Country | US
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Telephone | 917-916-9172
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OMOLARA ADERINBOYE
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Credential | M.D.
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Telephone | 917-916-9172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | N4233
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License Number State | TX
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